目的：探讨影响散光矫正型人工晶状体(Toric IOL)植入术后残余散光的术前危险因素，并构建及验证一个可用于临床的预测模型。

方法：回顾性纳入2023年10月至2025年8月于濮阳油田总医院及濮阳市第二人民医院行Toric IOL植入术的患者为研究对象，根据术后3 mo残余散光是否>0.25 D，将患者分为残余散光>0.25 D组和残余散光≤0.25 D组。收集并比较两组的术前临床资料与眼部参数，采用多因素Logistic回归分析筛选危险因素，并据此构建列线图预测模型。通过受试者工作特征(ROC)曲线、校准曲线及Hosmer-Lemeshow检验评估模型的区分度、校准度和临床适用性，并采用Bootstrap法进行内部验证。

结果：纳入患者103例103眼，残余散光≤0.25 D组72例72眼，其中男38例，女34例，平均年龄67.35±6.12岁； 残余散光>0.25 D组31例31眼，男19例，女12例，平均年龄69.87±6.45岁。残余散光>0.25 D组患者的糖尿病史比例、眼轴长度、角膜水平直径、平坦角膜曲率(K1)、陡峭角膜曲率(K2)、散光轴位及晶状体核硬度Ⅲ-Ⅳ级比例均高于残余散光≤0.25 D组(均P<0.05)； 多因素分析显示，角膜水平直径增大、K1增高、K2增高及晶状体核硬度分级升高(Ⅲ-Ⅳ级)是术后残余散光>0.25 D的危险因素(均P<0.05)； 基于此构建的列线图模型，其ROC曲线下面积(AUC)为0.794，敏感度为80.31%，特异度为75.20%。内部验证的一致性指数(C-index)为0.865。校准曲线及Hosmer-Lemeshow检验(χ²=5.231，P=0.734)表明模型预测值与实际值吻合良好。

结论：基于角膜水平直径、K1、K2及晶状体核硬度构建的列线图模型具有良好的预测效能，能有效术前预测Toric IOL术后残余散光风险，为临床个体化手术方案的制定提供参考。

METHODS: This retrospective study included patients who underwent Toric IOL implantation at Puyang Oilfield General Hospital and the Second People's Hospital of Puyang City from October 2023 to August 2025. Patients were categorized into two groups according to residual astigmatism at 3 mo postoperatively: >0.25 D group and ≤0.25 D group. Preoperative clinical data and ocular parameters of the two groups were collected and compared. Multivariate Logistic regression analysis was used to screen risk factors, and a nomogram prediction model was established accordingly. Receiver operating characteristic(ROC)curve, calibration curve, and Hosmer-Lemeshow test were adopted to evaluate discrimination, calibration, and clinical applicability of the model. Bootstrap method was applied for internal validation.

RESULTS: Totally 103 patients(103 eyes)were included, with 72 patients(72 eyes)in the group with residual astigmatism ≤0.25 D, including 38 males and 34 females, with an average age of 67.35±6.12 y; There were 31 cases(31 eyes)in group with residual astigmatism >0.25 D, including 19 males and 12 females, with an average age of 69.87±6.45 y. The proportion of patients with a history of diabetes, as well as the values for axial length, horizontal corneal diameter, flat corneal curvature(K1), steep corneal curvature(K2), astigmatic axis and proportion of lens nuclear hardness grade III-IV were significantly higher in the residual astigmatism group >0.25 D than those in the residual astigmatism ≤0.25 D group(all P<0.05). Multivariate analysis identified increased horizontal corneal diameter, higher K1 value, higher K2 value, and higher lens nuclear hardness(grade III-IV)as independent risk factors for postoperative residual astigmatism >0.25 D(all P<0.05). The nomogram constructed from these factors demonstrated that the area under the ROC curve(AUC)was 0.794, with a sensitivity of 80.31% and a specificity of 75.20%. The concordance index(C-index)of internal validation was 0.865. Calibration curve and Hosmer-Lemeshow test(χ²=5.231, P=0.734)indicated good consistency between predicted and actual values of the model.

CONCLUSION: The nomogram model established based on horizontal corneal diameter, K1, K2 and lens nucleus hardness exhibits favorable predictive performance. It can effectively predict the risk of residual astigmatism prior to Toric IOL surgery, providing reference for individualized clinical surgical planning.